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| | Connecticut Board of Examiners for Nursing Website This page contains information from draft minutes of Board of Examiners for Nursing Meetings. These particular excerpts are felt to be related to school nursing or important information for school nurses. If you have any questions regarding this information please contact the Board at (860) 509-7624. Please note that some of these issues (particularly scope of practice issues) are ongoing, information may seem at conflict from time to time. This page is set up with the more recent information first.
Below are some direct links to useful information from the CT Board of Examiners for Nursing, Department of Public Health and Department of Education web sites.
Department of Public Health Letter on EMTs Working
in Schools
Online License Verification
Licensure/Examination Information
February 6, 2002 SCOPE OF PRACTICE – FOLEY CATHETER
After discussion, as in the past, the “Foley Catheter” remains a licensed function. This is not a task that can be delegated to unlicensed personnel. April 3, 2002 PHLEBOTOMIST STATUTE
There was discussion regarding this statute and the finger stick glucose. Aides can do the finger stick glucose as long as the RN delegates, teaches, and supervises the aides to assure competence. September 4, 2002 DEPARTMENT OF EDUCATION MEDICATION ADMINISTRATION COMMITTEE UPDATE
Donna Canalis attended this committee meeting in which they are working on revising the current regulations for schools. An issue discussed was who can carry Epi-Pens? Should it be coaches, teachers, bus drivers? October 2, 2002 SCHOOL HEALTH ADVISORY UPDATE
Donna Canalis apprised the Board that she is awaiting a letter from Cheryl Carotenuti at the Department of Education with questions which need to be brought to the Board regarding school regulations. DEPT. OF EDUCATION – MEDICATION ADMINISTRATION COMMITTEE
The Medication Committee met on September 26, 2002. The purpose and agenda for this meeting was to review both the statutory proposals for the upcoming legislative session and the most recent version of the revised medication administration regulations. While the revisions are not complete, the subcommittee has made significant progress over the summer and welcomed everyone’s comments and reviewed the draft regulations. SCOPE OF PRACTICE – MEDICAL ASSISTANTS
Chair Bafundo and Wendy Furniss attended the Connecticut Medical Examining Board Meeting (CMEB) on September 17, 2002 to discuss the role of medical assistants. The Nursing Board is concerned that medical assistants may be performing or may be requested to perform licensed functions such as medication administration and patient assessments. Medical assistants are not licensed or certified in Connecticut and are not regulated by the Department of Public Health (DPH). DPH has the authority to file charges against a licensee who delegates licensed functions to an unlicensed person. DPH can also seek a Cease & Desist Order for an unlicensed person who is performing licensed functions. The CMEB concurs with the Nursing Board that licensed functions should not be delegated to medical assistants. The CMEB will defer to the advice of the Office of the Attorney General as to whether a formal policy should be issued regarding this matter. DPH currently issues an advisory letter explaining the tasks which a medical assistant can and cannot perform. November 6, 2002 SCOPE OF PRACTICE – MEDICAL ASSISTANTS
Wendy Furniss discussed this with the Board. Medical Assistants may not administer medication in Connecticut although their curricula teach this as there are other states which do allow medical assistants to administer medications. The Board is awaiting written advice from the Office of the Attorney General. MEDICAL PROTOCOLS AND STANDING ORDERS
There was a group meeting held at the Connecticut Hospital Association and they are currently working on. June 4, 2003 SCHOOL HEALTH ADVISORY UPDATE
The Department of Education regulations passed by a 4-3 vote to go to public hearing. The tentative plan is to go to public hearing this summer and return to the State Board in August then to the Legislature in the fall. September 3, 2003 SCHOOL HEALTH ADVISORY UPDATE
Valerie Bryan apprised the Board that she recently spoke with Cheryl Carotenuti of the Department of Education. The School Health Advisory Group meets quarterly with the Academy of Pediatrics and will be meeting again at the end of September. October 1, 2003 SCOPE OF PRACTICE – MEDICATION ADMINISTRATION TRAINING FOR CHILD CARE PROVIDERS
Dr. Angela Crowley and Rhonda Herschel presented to the Board a case study which they conducted exploring the development of medication administration training for child care providers in the State of Connecticut and implications for nursing liability as a result of providing this training. Topics discussed were delegation vs. professional activity and the role of the nurse consultant and scope of nursing practice. A rationale was presented in support of designating medication administration of child care providers by nurses as a professional activity, rather than as nursing delegation. This action by the Board will minimize undue liability for nurse trainers, thus expanding access to training and improving the services for children in child care programs in the State of Connecticut. Kathy Combe moved and Patricia Casey seconded that the Board designate medication administration training of child care providers as a professional activity of the registered nurse and will look at it on a case-by-case basis. This will prevent nurses from labeling it as “delegation” which, by definition, says that the responsibility for the outcome remains with the nurse. The motion passed with all in favor.
SCOPE OF PRACTICE – INFLUENZA IMMUNIZATION CLINICS
The Board received correspondence questioning whether or not it is acceptable for an unlicensed person, or retired unlicensed nurse to fill syringes with flu vaccine at a public clinic. It was the determination of the Board Members present that if you are administering the flu vaccine you must either prefill the syringe yourself or it must be done by a pharmacist or a pharmacy. Please refer to the General Statutes of Connecticut, Pharmacy Section 20-571 Section (1) “Administer” and Section (9) “Dispense.” Medication administration by any route remains a licensed activity, unless a specific statutorial exemption exists. November 5, 2003 SCHOOL HEALTH ADVISORY UPDATE
Valerie Bryan apprised the Board that the next meeting will be November 17th. Ms. Bryan will check with Cheryl Carotenuti to see if Board of Examiners for Nursing participation is required. Also she will invite Cheryl Carotenuti to attend an upcoming Board meeting to apprise the Board of recent Department of Education activities. December 3, 2003 CORRESPONDENCE AND INQUIRIES
Donna Canalis apprised the Board of the scope of practice inquiries received during the past month.
• Still receiving inquires as to whether or not an RN has to be working in an MD office where an LPN is employed. The answer is YES as the LPN must work under the direction of an RN, not under the direction of an MD.
• Questions received as to whether an LPN can administer Remicade for arthritis treatment in an MDs office with no RN available. An RN must be available in the MDs office since an LPN works under the direction of an RN.
• There is a need for education in the MD community that Medical Assistants cannot administer medications. This is a licensed function.
• Questions received as to whether or not an LPN can triage in the ER – This is not within the scope of practice of an LPN, since the LPN must work under the direction of an RN and contribute to the total assessment. February 4, 2004 SCOPE OF PRACTICE – VERBAL ORDERS
Chair Bafundo discussed the issue of LPNs receiving verbal orders. The LPN can assist in the collection of data, which is then turned over to the RN. The RN has the responsibility of evaluating and assessing the patient. If it is a new order or a change in order the RN must determine if it is consistent with the current plan of care. When the LPN is receiving a verbal order for an anticipated change, the RN should be notified and consulted. If the LPN implements the order without notifying and collaborating with the RN, the LPN is acting out of his/her scope of practice and disciplinary action could occur. The LPN would be brought before the Board of Examiners for Nursing for disciplinary action. The RN would not be held responsible if the LPN acted independently, and failed to notify the RN. A misconception has developed that an LPN “cannot speak to the doctor.” This is false as anyone on the health care team may speak to the physician. April 7, 2004 SCHOOL HEALTH ADVISORY UPDATE
Valerie Bryan spoke with Cheryl Carotenuti of the Department of Education and the DOE guidelines for self-testing glucose monitoring are not on the DOE Web site. They are presently working on the qualifications for school nurses and will pursue Connecticut guidelines. February 2, 2000 - School Issues-Berlin School System
Kathleen Boulware, supervising Nurse Consultant, provided the Board with an update on the January newspaper article regarding staffing levels at the Berlin High School. Both the school system and the Department of Education were contacted. The RN School Nurse remains on site at the high school at all times and supervises all activities of the LPN. There are three elementary schools each staffed with a full-time registered nurse. It appears that the school system is in compliance with the Board of Education Regulations.
April 7, 1999 SCOPE OF PRACTICE-PHYSICIAN'S ORDERS - The board reviewed the scope of practice question as to whether or not a licensed nurse could accept and implement a physician's order for medication if relayed by non-nurse office staff on behalf of the physician. The Board noted that nurses must receive verbal orders directly from the physician or other practitioner with appropriate statutory authority. The purpose of direct communication with the prescriber is to allow the nurse to discuss and/or verify the order.
- SCOPE OF PRACTICE-SCHOOL NURSE COMPLAINT
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- Wendy Furniss provided the Board with a report of Kathleen Boulware's on-site visits to the Cromwell School System on March 5 and 8, 1999. The Board reviewed the report and would like a review to be done at the end of June to see if all the proposals actually went into effect.
March 3, 1999 SCOPE OF PRACTICE-LICENSED NURSES WORKING AS UNLICENSED ASSISTIVE PERSONNEL Assistant Attorney General Patricia Gerner was present for this discussion with the Board. - Licensed nurses can accept a job as unlicensed assistive personnel (UAP) and are not required to turn in their license, but cannot hold themselves out as licensed nurses (not misrepresent self).
- Standard to hold such nurses to is a case-by-case review of facts. Employers should not be able to expect LPN/RN behavior from those employed as UAPs (both parties must be honest re: role).
- If then one acts like a licensed nurse then the Board hold them to the standard of their license if something goes wrong (if individual does not stay within limit of job description).
- Employer is responsible if they don't employ enough licensed people to manage a unit-can't expect the UAP to perform at a higher level simply because institution is not well staffed. The UAP school report problems to licensed staff, but should not act in a licensed capacity (should continue to report the problems up the chain of command to cover oneself). (board is not in total agreement, but will accept the interpretation of the Attorney General's Office).
- Emergency situation-how should the individual respond - review case-by-case. A UAP should first attempt to get a licensed nurse-if cannot and has training and ability, the nurse "should" step in and do what she can to save the patient and should report that to supervisor as soon as possible )and the Board would not discipline for acting outside their job description). (Department of Public Health, institutional licensing unit, has jurisdiction to investigate complaints with the patient outcomes based on lack of staffing).
- Board not in consensus regarding always holding up a person to highest level of licensure. the emergency situation is variable so these would need to be judged on a case-by-case basis. UAP job description probably includes "get help quickly" in emergency. Employer might shift "risk/liability" to the individual who acts outside job description (so the nurse/UAP must make decision based on present situation.
SCHOOL NURSE COMPLAINT (See April 7, 1999) - Wendy Furniss provided the Board with a written update on the progress of the complaint regarding LPN Practice and Supervision in the Cromwell School system. Interviews with the RN Nurse Supervisor, Nadine Schwab from the Department of Education, and with Superintendent James Gere have been completed. It appears that the situation in the Cromwell School System has been ameliorated and will be fully addressed once the referendum funds are available. Currently daily on-site RN supervision is provided at all school and is available for emergencies. In the near future, the RN supervisor will be relieved on any individual school assignment. The Department recommends closing the complaint at this time. The Board would like information on the number of care plans, the number of compromised children, the number of aides who come in, the number of respirators, how many medications are administered, when care plans are being done, and who will cover if the supervisor is out ill. This will be discussed at the April 7th Board meeting.
February 3, 1999 SCOPE OF PRACTICE-LICENSURE ISSUES (See March 3, 1999) - The Board reviewed the informal advice from the Attorney General's Office regarding licensed nurses functioning in the role of unlicensed assistive personnel. The Board requests that Assistant Attorney Generally attend the March 3rd Business meeting to discuss this advice with the Board.
SCOPE OF PRACTICE-SCHOOL NURSE COMPLAINT - This issue was tabled for discussion at the March 3rd meeting.
December 2, 1998 SCHOOL NURSE COMPLAINT (See March 3, 1999) - Wendy Furniss provided the Board with a document which explained how the situation in the Southington School System has been resolved. Patrice Donovan discussed the problem with the Cromwell School System, which presently has one registered nurse and two licensed practical nurses to cover three schools. Wendy Furniss will review the Cromwell situation and will follow through using the same procedure as used with the Southington School System.
July 15, 1998 CEASE AND DESIST CONSENT ORDER-G JOSEF SZAJDA-UNLICENSED - Legal Office Attorney Stephen Miltimore present the Board with a Consent Order for Mr. Szajda. Mr.Szajda was not present and was not represented by counsel. Patricia Casey moved and Mary Ellen O'Hurley seconded that Mr. Szajda cease and desist the practice of nursing without a license immediately. The motion passed unanimously. The Board recommended that the physician Mr. Szajda is employed by be referred to the Connecticut Medical Examining Board and that the nurse in that office be referred to this Board for improper delegation to an unlicensed person.
June 3, 1998 SCOPE OF PRACTICE-DEPARTMENT OF EDUCATION ADVISORY MEETING - Wendy Furniss attended the May 29, 1998 Advisory Meeting. The curricular (sic) letter re: LPN scope of practice is being reviewed by the Department of Education's Legal Office and can then be signed and sent to all school systems. The Department of Education is now sending the Board's disciplinary lists to all superintendents which is appreciated. The issue of medication administration was raised. The Department of Education reviews these procedures only in private schools (but not in regulation education programs of public schools) for compliance. The Department of Education will convene a second subcommittee to review and revise the Department of Education's medication regulations. Representatives from various agencies, including the Board and the Department of Public Health, will be included in this subcommittee. The next meeting is scheduled for September 11, 1998 at 1:00 PM at the Department of Education.
SCOPE OF PRACTICE-NURSES' ACCEPTANCE OF ELECTRONICALLY TRANSMITTED MD ORDERS - Wendy Furniss recently attended the meeting of the Connecticut Medical Examining Board to discuss the Advisory Opinion from the Attorney General's Office regarding nurses' acceptance of electronically transmitted MD Orders. The Board had posed three questions to the Office of the Attorney General (OAG) regarding faxed and electronically-transmitted physicians' orders and orders bearing a stamped signature. The OAG's research revealed no specific law or regulation relating to these questions. However, based on the research, the Board concluded that nurses may accept and act upon physicians' orders signed and received by fax and those transmitted electronically, where the personal identification code is properly secured. Neither of these types of orders would require further countersignature. The Board requested the comments and suggestions of the Connecticut Medical Examining Board regarding the acceptance of orders signed by rubber stamp It appears in light of the case cited on page 6 of the OAG Opinion, that under certain circumstances, such as a disability, these orders might be accepted, provided that security of the stamp is assured. Authentication of the physical signature of an individual seems to be the critical factor. The Medical Board concurred with the above as long as the nurse feels security is in place.
SCOPE OF PRACTICE-LICENSURE ISSUES (See February 3, 1999) - The question has again arisen regarding the unlicensed positions in health care facilities. In February of 1994 the Board stated that it was essential that any unlicensed person, or those functioning in the role of an unlicensed person regardless of the license they hold, function with in the scope of practice of that role to which they are assigned. In March of 1994 the Board advised that the standard to which an individual, holding such a license as a practical nurse, would be held in the event that there was a complaint against the nurse for care even provided in the role of the Patient Care Technician, would be the standard of that of a licensed practical nurse. The Board discussed this issue again and it was the unanimous decision of the Board to place this on the September agenda for further discussion.
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Association
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